Lokal ileri ve/veya lenf düğümü tutulumu olan rektum kanserinde neoadjuvan kemoradyoterapiye yanit ve sfinkter koruyucu cerrahinin araştırılması

Year 2018, Volume: 11 Issue: 3, 314 - 322, 25.12.2018

Şükran Eskici Öztep , Eda Bengi Yılmaz , Mehmet Özgür Türkmenoğlu

https://doi.org/10.26559/mersinsbd.443111

Abstract

Amaç: Lokal ileri ve/ veya lenf düğümü tutulumu olan rektum kanseri
tanısıyla uzun dönem neoadjuvan kemoradyoterapi uygulanan olgularda tümör ve
nodal evrede gerileme ve patolojik yanıt oranlarının belirlenmesi
amaçlanmıştır. Yöntem: Mersin Şehir
Eğitim ve Araştırma Hastanesi Radyasyon Onkolojisi Bölümünde 2017 yılı
içerisinde neoadjuvan kemoradyoterapi uygulanmış olan lokal ileri ya da lenf
düğümü metastazı olan rektum kanserli 23 olgunun verileri retrospektif olarak
değerlendirildi. Tüm olgulara kemoterapi, radyoterapi ile eşzamanlı olarak
uygulanmıştır. Yirmi bir olguya neoadjuvan kemoradyoterapi bitiminden 4- 8
hafta sonra küratif cerrahi yapılmıştır. Neoadjuvan kemoradyoterapiye yanıtın
değerlendirmesi ameliyat öncesi evreleme ile patolojik evrenin
karşılaştırılması ile yapıldı. Rezeksiyon materyalinde herhangi bir kanser
hücresi gözlenmemesi patolojik tam yanıt olarak değerlendirildi. Tümör ve nodal
evredeki gerileme kısmi yanıt olarak değerlendirildi. Bulgular: Olguların ortalama yaşı 57.3± 9.8 idi. Tedavi öncesi
yapılan radyolojik incelemelerde olguların 9’unda (%39.1) T3, 14’ünde (%60.9)
T4 tümör saptandı. Olguların 14’ünde (%60.9) lenf düğümü metastazı izlenmezken,
9 olguda (%39.1) lenf düğümü metastazı saptandı. Tümörün yerleşim yeri; 8
(%34.8) alt rektum, 7 (%30.4) orta rektum, 8 (%34.8) üst rektum idi. Sfinkter
koruyucu cerrahi olguların %71.4’üne uygulanabildi. Neoadjuvan kemoradyoterapi
sonrası olguların 7’sinde (%30.4) patolojik tam yanıt, 13’ünde (%56.5) ise
kısmi yanıt izlendi. Neoadjuvan tedaviye yanıt ile tümör yerleşimi ve sfinkter
koruyucu cerrahi uygulanabilirliği arasında yapılan istatistiksel analizde
anlamlı farklılık izlenmemiştir Sonuç:
Neoadjuvan kemoradyoterapi uygulanan olguların büyük bir kısmında tümörde boyut
ve/ veya evre gerilemesi sağlanabilmektedir. Evre gerilemesi, sfinkter koruyucu
cerrahi uygulanabilirliğini arttırmamaktadır.

Keywords

Lokal ileri rektum kanseri, neoadjuvan kemoradyoterapi, sfinkter koruyucu cerrahi

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